Provider Demographics
NPI:1073690491
Name:PROFESSIONAL HOME SERVICES, INC.
Entity Type:Organization
Organization Name:PROFESSIONAL HOME SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECA
Authorized Official - Middle Name:NUNEZ
Authorized Official - Last Name:GRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:305-827-1211
Mailing Address - Street 1:6001 NW 153RD ST
Mailing Address - Street 2:SUITE 152
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2419
Mailing Address - Country:US
Mailing Address - Phone:305-827-1211
Mailing Address - Fax:305-827-1320
Practice Address - Street 1:6001 NW 153RD ST
Practice Address - Street 2:SUITE 152
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2419
Practice Address - Country:US
Practice Address - Phone:305-827-1211
Practice Address - Fax:305-827-1320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL209740961251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL650884700Medicaid